The overall goal of this research is to increase our understanding of the relationship between the cultural competence of clinicians and healthcare outcomes in racial minority patients with hypertension. The knowledge gained through this study will be relevant to nurses and all clinicians who must develop therapeutic cross-cultural relationships with their patients to be effective healthcare providers. Inequality in the healthcare received by racial minorities has been widely documented. Cultural competence training of clinicians is a proposed strategy to reduce inequalities that emanate from the patient-clinician encounter. Few studies have documented the relationship between clinician cultural competence and improved healthcare outcomes or the mechanisms by which cultural competence may improve care. The specific aims of this proposed study are to: (1) test the relationship between clinician cultural competence and level of blood pressure, and (2) to determine what factors mediate the relationship between cultural competence and level of blood pressure. Two levels of mediation will be tested. The first level tests patient trust in the clinician and satisfaction with the clinician as independent mediators between clinician cultural competence and patient adherence. The second level of mediation tests patient adherence as a mediator between the variables, patient trust in the clinician and satisfaction with the clinician, and the final outcome variable, blood pressure level. A correlational, cross-sectional design with the physician as the unit of analysis will be used to evaluate the proposed relationships between clinician cultural competence, mediators of cultural competence, and level of blood pressure. This study is a sub-study of a randomized controlled trial using physician and patient education strategies to improve patient adherence. The racial composition of participants (African American and white) and the range of relevant variables collected make the parent study an ideal opportunity to test the candidate's hypotheses. Campinha-Bacote's conceptual model, "The Process of Cultural Competence in the Delivery of Healthcare Services", provides a framework for operationalizing the measurement of clinician cultural competence. The candidate will explore testing the hypotheses using a multi-level structure with patients nested within clinicians since within-group independence of patients treated by the same clinician cannot be assumed. Findings from the proposed study have the potential to further our understanding of the mechanisms by which clinician cultural competence may be associated with improved control of chronic diseases in vulnerable populations who carry an increased disease burden. [unreadable] [unreadable] [unreadable]